2nd Anonymous: You’re confusing “ordinary physical exam” with a laparotomy. If you can’t remember the difference, you’re in trouble.

Yes, getting hold of a uterus through any sizable abdominal fat deposit is hard. What, you thought this was easy? Laparoscopy avoids the incision complications, anyway, and avoids you having to plunge your hand into them. Keep that in mind.

Likewise, the ultrasound will go faster and produce a sharper image if you insert a probe to scan the uterus from the vaginal area; the closer probe and higher frequency produce better results, as well. Next time, read your manual, please.

3rd Anon.: Actually, I’ve never heard that from anyone who didn’t have hypothyroid. Guess you’re just lucky.

4th Anon.: “Litigious animals”? You mean you operate only on lawyers? Talk about a specialist…

Seriously, they like getting it even less than you like inserting it. That’s speaking as an “American SOB”, btw.

P.S.: You’re wearing gloves, so why are you kvetching about intertrigo?

5th Anon.: I’ll congratulate you on not being as insulting as your attending, though I admit he was under unusual stress. I presume you eventually got it in?

As a physician, I can tell you that the rude comments posted in this thread are not common to the most of us in the profession. It is unacceptable to dehumanize patients and it is exceptionally immature to do so in an “anonymous” public forum.

To put some of the comments in perspective…

Dealing with pediatric medicine is often compared to veterinary medicine because kids can’t usually tell you what’s wrong with them. Neither kids nor obese people are beasts, certainly. However, there is some truth to the fact that otherwise simple tasks are more difficult with obese patients compared to non-obese ones.

From my own experiences, it is neither a pleasant nor normal task to resort to using procedural sedation and the effort of two staff members each holding up a leg that was wider than my own entire torso to conduct what should have been a routine gyne exam for a morbidly obese patient. In this case, because her obesity prevented her from moving her legs normally, whether you blame her family more for perpetuating her disease than focusing in on anything she could’ve done on her own, the fact is that when she comes in with whatever medical problem she has… we doctors treat her the best we can. And sometimes it has to require extraordinary measures in order to do so.

Health is only going to be achieved when patients participate in the process, too, though. The days of strict “Doctor knows best” are gone, but some doctors are better than others at reaching a middle ground with their patients so that shared goals can be reached.

As an FYI, the fastest “healthy” weight loss rate recommended by educated professionals is 1 pound on average per week (approximately 500 less calories per day than whatever your daily intake would be at a steady state of weight). The goal weight loss over one year should be no more than about 50 pounds. Anything more than that is more likely to be unsustainable and result in regaining the weight back. Both BMI’s greater than 30 or less than 20 can be associated with specific health risks. And none of the criteria for diagnosing bulemia, anorexia nervosa, or body dysmorphic disorder rely on BMI as defining characteristics of the disease.

A healthy exercise regimen might include begining with as little as 30 minutes of moderate activity three times a week. The Preventative Health Task Force actually publishes specific guidelines for the above if you care to read them yourselves.

Unhappily, the only reason I found this forum was that I was looking for the origin of the myth that obese patients could be sent to the zoo for CT/MRI imaging. (Of course it is a myth, although I haven’t found any indication of where it started). Like I said earlier, no one should be made to feel like a beast. It is sad that so many of you are caught up in this argument of who is more the animal.

I joke that I have gained and lost 1,000 pounds in my lifetime. The truth is I have always had to carefully manage my weight. I was a runner for a long time. Ran my first marathon, had a car accident 6 months later. NO more running. Had to learn other ways to stay healthy and had to change my eating habits.

Upon taking a steroid two years ago for complications due to my back surgery, I gained a lot of weight. Once off the steroid I followed Weight Watchers and started walking as soon as I got the go ahead from the doctor. Nothing. Started writing down everything I ate and recorded my exercise. Nothing. I was tired, I assumed from the extra weight. Didn’t even notice that my hair was falling out.

Didn’t want to go to the doctor. Didn’t feel sick. Figured it was an over 40 thing and had to work harder. Nothing helped. Was eating 1000 calories, working out 5 days a week and lost 4 pounds in 7 months.

When I went to the doctor, she immediately told me to eat less. Showed her my food diary and told her I was tired. She suggested anti-depressants.

Long story short and a better doctor later, Needed a full thyroidectomy, got it, and am on with my life.

There are doctors that are prejudiced against people who are overweight and are obviously not capable of doing the job they are paid to do.

Sad part is, you can have a very high level of education and still be ignorant.

The name calling throughout here is a clear testament to that.

Here is the deal. NO one wants to be overweight. I think blind tolerance is dangerous. However, I would never determine someone to be less of anything because they are overweight. Their demons show for the world to see. I pity them. I know that sounds condescending, but I truly do. I know what it’s like to have someone stare at you and judge you.

But know what? The whole desire for acceptance is unrealistic. Short of a medical condition, you know that you are the reason you are overweight and you feel lousy about yourself. Somewhere inside you know that there is some truth to the judgement out there and you can’t blame anyone for it.

All that being said, I can’t believe the hate I have read. There are so many things out there that are so much more horrible. I pray for all of you.

There isn’t any need to hate someone who is overweight. You are making the issue your own.

I’m a 30+ woman who at 275 pounds and 5′7″ is considered morbidly obese, although with muscle mass counted in, I’m probably more comparable to someone on the low end of the obese range. (I was 5-10 pounds over-fat when I was 190 pounds.)

I was a relatively active kid (always in swimming lessons, on the swim team, and at various points also took skating, gymnastics, floor hockey, cross-country skiing….)

I’m a relatively active woman, despite my size. I’ve done one of those looooonnnnng all-weekend walks to end breast cancer. I can swim a couple of kilometres. I gave up my car for a bike and public transit. I’ve always been into camping and canoe trips, since I was 13. Even at 320 pounds, my highest weight ever, I was still taking friends on canoe trips, on which I would simultaneously solo-portage my canoe and a 60-75 pound pack. I garden. I walk to stores. I hate most traditional sports, and definitely have my couch potato moments, but I move, too.

I have always had a lot of muscle. Embarrassingly, when I was 14, during one of the few periods in my life when I didn’t look overweight at all, the school nurse made me get off and back onto her scale three times so she could rebalance it at zero in disbelief. She thought it was malfunctioning suddenly. I guess she finally resigned herself to believe the number, because with my classmates listening in line behind me, she finally looked up at me and said “My God, what do you do? Do you lift weights? You look to be about 140 or 150, not 180.” I told her I swim, and booked it out of there.

I know that when people first see me as an adult, they don’t imagine I’m so fit because of the fat layer on top, my massive caboose, and the size 20-24/26 or 3X clothes I wear. And I see the looks on their faces, especially when I occupy more than my ‘fair share’ of space in a bus, plane, or theatre seat. (And yes, I’ve had a Digital Imaging Technologist tell me to my face that she couldn’t get the image she was trying to get, because of my belly.)

I never heard of either your blog, or BigFatBlog, until today when I was doing research to help a young woman who is 5′9″, weighs 125, and wants to lose the ‘extra 25′ to be 100 pounds by Christmas.

(It’s very hard to convince a young woman that she’s body dysmorphic, or bulemic, thanks to the anti-fat sentiment that is ubiquitous everywhere.)

I understand your desire to vent, Kevin. I have enough friends who are doctors, and I’ve worked in social services with some very difficult clients, and I know that a little ‘black humour’ can help you vent a frustration and move on. I’m giving you the benefit of the doubt that the things you’ve typed here are not actually your day-to-day attitude, but a letting off of steam, so to speak. But context is critical. I do wish you’d be more tactful in a publicly-searchable blog. Save it for where it won’t damage people, or your reputation.

I thought I’d share my experience, that might be of interest to you and your readers (both health care providers, and those visiting from BigFatBlog) I’ve been somewhat overweight since I was 8 years old. The doctor I’ve had since I was 3 or 4 was always so wonderful about it. Despite my mother’s concerns (shared with him in front of me from the age of 10 on!) he was always friendly, encouraging, and nice with me. And he never advocated ‘dieting’ in any way. He would simply encourage me to ignore the other kids’ comments, keep active, and eat healthy, just having a junk food treat now and then. Completely liveable!

On that advice, I stayed active, stayed positive and confident, and usually stayed within 10-20 pounds of my healthy weight until I was in my late teens/early 20’s.

It’s true I hated running and most sports I had to be on my feet for. I avoided them like the plague, after age 11 or 12. Two of the reasons for that, I only much later understood. One was what was later diagnosed by the head physician at a Toronto hospital as exercise-induced asthma, and the other was my discomfort running because I require orthopaedic shoes for a 1.5 inch leg length difference and longer-leg collapsed arch, that have always caused my frequent hip and knee pains. But my favourite sport, swimming, wasn’t affected much by these. (A disproportionate number of Olympic swimmers have had asthma. I think the rhythmic breathing of the sport actually helps us. That, and no one can hear me breathing hard/gasping/panting, so I don’t get embarrassed.)

After that, my father’s negative comments (about me getting to be ‘as big as a house’) got to me, and I tried a diet. It wasn’t a fad diet, or a gimmicky one, but it did restrict calories. People lauded my success in dropping 30 pounds (some was muscle mass) over 3 months (which is the so-called ‘healthy’ pace, right?).

When I resumed the eating that had maintained my weight in a balanced way before I ever dieted, I regained 60 pounds. Over 10 years, I went through this cycle three times. (That’s just three times I tried 3-6 months of healthy but restricted eating, folks.) Total ultimate weight gain? 140 pounds.

Yes, it’s true. I didn’t seriously STRUGGLE with my weight until after the first diet must have altered my metabolism.

So I spent a year working with a doctor at McMaster University Medical who specialized in eating disorders and healthy weight loss. That year I reported every bit of activity, every food and its portion (right down to a single Hershey’s Kiss) – all of it, to her. We met every 1-2 weeks. She was encouraging and honest, and would call me on it if I ate too much or too little of any food group in a given week.

And the result? She said, at the end of the year, “I really don’t get it. You ABSOLUTELY should have lost 40 pounds in a healthy way by now. You’ve gained 15.”

The medical tests began. It took a while (years) to tease it all out, but I had a combination of factors working against me.

Hypo-active thyroid was the first factor to be identified. We spent a year sorting out the right medication level. That helped some, but there still seemed to be a missing piece.

I developed Mono, and it stuck around for too long of a time, even for Mono. More tests were done, to see if something could be contributing to my fatigue lasting on and on. Bingo! Insulin resistance related to both PCOS, and Type 2 diabetes. Metformin successfully treated both. (My last hemoglobin test showed an average blood sugar of 5.6 over the previous three months. And for the first time in my life I have truly regular cycles.)

A year after these diagnoses, I happened to be diagnosed with ADD by my childhood doctor (then confirmed by a psychiatrist specializing in AD/HD), after he learned more about its often-differential presentation in women. I was begun on Ritalin. This had an interesting side-effect. I’ve heard people say that they worry that Ritalin can cause appetite loss. That was definitely not the case with me. But for the first time in my life, I truly UNDERSTOOD my appetite.

For years I had commented that unless I was famished, I never truly knew if I was actually hungry, or by how much. I always felt like I could eat. If food was served, or the clock suggested it was time to eat, or everyone around me was eating, I filled up a plate and ate. And I ate everything on my plate, because nothing in me ever told me “OK, you’re done.” (Unless I’d eaten enough to be painfully full, like at holidays!)

After starting the Ritalin? Either my appetite control mechanism kicked in, or I became able to tune in to it. I suddenly found myself being able to guage how much was enough, either for the first time, or probably since very early childhood. I effortlessly lost 45 pounds (w i t h o u t trying) and it has stayed off for almost a year.

(At that point I began consciously maintaining my weight at its current level, because I am wearing my ’smaller’ clothes that I hauled out of storage, and can’t afford to replace my whole wardrobe if I drop another 15 pounds right now.)

There’s an interesting chapter on ADD and disordered eating in Patricia Quinn and Kathleen Nadeau’s text “Gender Issues and AD/HD: Research, Diagnosis and Treatment”. It’s definitely worth looking at, for anyone working in medicine.

In sumary, I guess I want to say this:
- others’ attitudes can help make or break success (my doctor’s helped me, my dad’s drove me to try a diet that ended up hurting me by slowing my metabolism, and causing a much worse weight gain)
- there may be a myriad of subtly-related issues that will take years to discover and sort out
- there can be some surprising contributing factors
- not all of us who are big are in pain or hyper-defensive about it, by some miracle
- even when you have a correct understanding, a healthy attitude, a willingness to ‘do something about it’, and a healthy fitness/activity level, people can still see you as a lazy fat-a*s
- medical training should probably include a good look at all the different things that CAN influence or promote weight gain or metabolism, and when initial efforts at reasonable weight control fail, these should be examined as possible contributing factors. (Preferably not taking 2.5 decades to assess and address.)

I’m so glad I had the privilege of a doctor who believed in lifelong learning, and had the wisdom and perhaps the humilty to contemplate ADD in my adulthood, rather than being dismissive or even embarrassed it wasn’t caught when I was a child. It wan’t considered BECAUSE of my weight or appetite issues, but turned out to be a very significant piece of the puzzle in my case. (Dr. B, if you happen to ever read this, my hat’s off to you!!!!)

Because they go back to their previous bad habits once the excess weight is off, or often before its even had a chance to come off.

I was in the “obese” weight range just over 5 years ago. Then, I lost 80 lbs in a year and now I’m in the lower end of the “healthy” weight range. I’ve stayed that way ever since by keeping daily track of calories, yet still eating the foods I like in moderation. Keeping track of what I eat is a very small price to pay to have the body and the life I want. I only wish I’d learned that 7 years earlier then I did. Anyone can lose weight, it just takes effort, self control and knowlege of how the human body works.